HEALTH & FITNESS

Heart disease begins early in life
Dr R.P. Sapru
It is common knowledge that coronary artery disease is widely prevalent, even among the economically weaker sections of society. It is not surprising, therefore, that the mere mention of coronary artery disease very often elicits a panic reaction because of a perceived immediate threat to life and possible long-term impairment of the quality of life.

Running: how to avoid injuries
Dr Ravinder Chadha

Injuries form an integral part of an athlete's or sportsperson's career span. Major causes for injuries are training errors, faulty action, lack of strength, flexibility, etc. The most common training errors are rapid changes in the duration, frequency and intensity. Other problems can be defective shoes, hard/uneven running surface, etc. Running/jogging has also become an important part of the training programme for reducing weight and improving cardiovascular fitness. The commonly encountered injuries are:

Health Notes
Middle class kids ‘more  likely to be obese

LONDON:
Middle class parents need to be careful about the kind of food that goes into their kids’ mouth, for a survey has found that their children are more likely to be overweight when compared to kids from poor households.

 

 

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Heart disease begins early in life
Dr R.P. Sapru

It is common knowledge that coronary artery disease is widely prevalent, even among the economically weaker sections of society. It is not surprising, therefore, that the mere mention of coronary artery disease very often elicits a panic reaction because of a perceived immediate threat to life and possible long-term impairment of the quality of life.

The disease process is usually initiated fairly early in life but comes to light only when the blockage in the artery(ies) is severe enough to interfere with the functioning of heart muscle. Blockages are of no consequence unless they begin to impair the flow of blood in the concerned vessel. In keeping with the principles of hydrodynamics, blood flow through a blood vessel is not affected unless the narrowing is at least 50 per cent or more! Once the blockage assumes a particular size the patient would first begin to feel chest discomfort during exercise recognised as angina of effort.

With increasing blockages, the severity of symptoms increases till the patient begins to experience symptoms even at rest. If at any point the blockage is complete a heart attack will ensue. All patients do not follow this orderly course. In some cases, the disease may come to attention only with a heart attack out of the blue, without warning; there are all kinds of variations in between.

The point to understand is that the individual remains unaware of the disease before symptoms appear. Just because the patient was feeling alright does not mean that there was no disease.

That is as far as it goes; we still do not know precisely how and why the abnormalities that cause the few smooth vessel cells in the walls of the arteries to behave the way they do, arise. Further, we are still unable to predict how the disease may progress in a given individual. We do, however, have a fairly clear understanding of various factors that accelerate the progress of the disease or increase the chances of complications such as a heart attack. They are called “risk factors” like diabetes, hypertension, smoking, increased fats in the blood, obesity, etc. These conditions are just what the term says — risk factors — not the cause of the disease!

Once the symptoms of the disease are manifest, and a determination is made that the blockage(s) needs to be treated, a further dilemma arises from the fact that neither bypass surgery (CABG) nor angioplasty actually cures the disease. These procedures undoubtedly provide substantial relief and help to prolong life as well as improve the quality of life of survivors, but the fact remains that they do not cure the disease. Consequently, there are substantial chances that the disease may reappear in the same area or appear in a new area, and in the case of patients who have had surgery, the disease may even appear in the vessels that have been positioned to provide the alternate channels for the supply of blood to the heart muscle. In such cases, it may become necessary to undertake a further angioplasty or surgery.

Given the will, it is now possible to delay the appearance of the disease and to mitigate possible consequences should the disease appear nonetheless. Further, for those in whom the disease does become manifest, it is possible to save life in some, though not all, cases and to reduce the chances of complications thus improving subsequent quality of life. This is possible only with a suitable programme aimed at determining the risk of an individual to develop the disease, then to structure a suitable customised surveillance plan to monitor the progress of the disease as well as the appropriateness of the defined treatment plan and introduce course corrections as and when deemed necessary.

Such a surveillance programme is also necessary to gauge the progress of disease in patients who have received treatment whether with drugs alone or even after angioplasty or CABG. In either instance the aim is to slow down or halt the progress of disease or prevent complications in patients who may develop the disease in spite of suitable treatment.

The process of surveillance is a combination of historical and laboratory data designed to detect at the earliest possible time any change in the status caused by the reappearance of the disease or the appearance of a new disease at another location.

In the course of the surveillance programme it becomes necessary at some point in time to make a formal assessment of the actual location of the blocks as well as their severity. This can only be achieved by actually visualising the lumen of the coronary arteries. The only available means to do this is with X-rays; ultrasound is not suitable. Unfortunately, the inside of the coronary arteries cannot be visualised by simple X-rays; it is necessary to inject a substance that is opaque to X-rays called radio-opaque contrast.

—————The writer is retired Head, Department of Cardiology, PGI, Chandigarh.


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Running: how to avoid injuries
Dr Ravinder Chadha

Injuries form an integral part of an athlete's or sportsperson's career span. Major causes for injuries are training errors, faulty action, lack of strength, flexibility, etc. The most common training errors are rapid changes in the duration, frequency and intensity. Other problems can be defective shoes, hard/uneven running surface, etc. Running/jogging has also become an important part of the training programme for reducing weight and improving cardiovascular fitness. The commonly encountered injuries are:

lAnterior knee pain Heel pain lShin pain lAchilles tendinopathy Iliotibial band syndrome. Injuries occur in tissues subjected to repetitive stress (which is several times the body weight). In distance runners, these injuries occur due to excessively repetitive use of tissues exceeding the maximum capacity. The body's musculo-skeletal system is capable of adapting to changes in the stress, but this requires a certain period of time to accommodate. Training within the body's limit with a slow increase in stress results in enhanced tissue strength thereby preventing injury. To achieve this goal, a carefully designed training programme is critical.

The training regimen should comprise strenuous activity alternating with light activity in-between to favour recovery. Strenuous activity should entail appropriate and a proportional increase in activity. Most runners undertake three days of strenuous activity with three days of not-so-strenuous activity. An increase in the weekly mileage should be not more than 5 per cent to 10 per cent. It is advisable to under-train than endangering one’s plan by getting injured through over-training. An adequate and appropriate training programme on an individual basis is most desirable. Good coaching entails an appropriate goal and proper implementation.

Injuries are generally sustained when aerobic activity is increased more than the body's ability to adjust to the strain. Injury occurrence calls for a reduction in training rather than stopping altogether.

Alternatively, the aerobic conditioning can be changed to cycling, steppers, running in water, etc.

It is of paramount importance to assess the biomechanical defects of lower limbs as running depends on the proper function of each part --- feet, legs, hip, etc. The examination should include:

  • Leg length insufficiency lHip motion lStrength and flexibility of muscles.
  • Foot shape (flat or high-arched)

The quality of shoes plays a vital role as far as injuries go while running. Shoes should be carefully inspected for any excessive wear and tear or distortion, particularly the heel wedge and heel counter. People running/jogging everyday should change shoes every 300 miles of usage.

Stretching to attain flexibility should be an integral part of the daily training regime---Stretching should be done after adequate warming up and followed by a cooling down.

The following exercises are extremely significant:

  • Hamstring stretch: Sitting on the floor with legs straight in front of you. Reach for the toes until a down-stretch is felt in the back of the thigh. Hold on for five seconds. Repeat.
  • Hamstring strengthening prone/ standing hamstring curls with weights and stretch band.
  • Quadriceps stretch: Stand facing a stationary object for support. Bend one knee as far as possible, reach the back and grasp the foot. Pull the heel toward buttocks until a stretch is felt in the front of the thigh. Hold on to this position for 10 seconds. lCalf strengthening: Step up on a stable platform or staircase with weight supported by the balls of feet. Place one hand against a wall for support. Tuck your one foot behind the other foot-heel. With your back straight, rise on the toes. Hold on for a second and then return to the original position. Do 10 to 12 repetitions, and then switch legs.



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Health Notes
Middle class kids ‘more likely to be obese’

LONDON: Middle class parents need to be careful about the kind of food that goes into their kids’ mouth, for a survey has found that their children are more likely to be overweight when compared to kids from poor households.

And the leading reason for this, the survey finds, is the increasing numbers of working mothers.

The study was carried out by researchers at the Institute of Child Health at University College London and Great Ormond Street Hospital who followed the lives of more than 13,000 children born in the UK between 2000 and 2002.

They noted that with more and more middle class women stepping into the professional world, kids are increasingly being left behind with nannies or at nurseries where not enough attention is paid to diet or physical exercise.

As a result, kids are now indulging in rather unhealthy habits like eating loads of snack foods, drinking sweetened drinks, as well as spending hours in front of the TV. — ANI

Latest therapies for breast cancer patients

WASHINGTON: A new study has found that newer drug therapies available since the 1990s, in particular aromatase inhibitors, improve the survival of women with metastatic breast cancer in the general population.

The study was conducted by a team of researchers led by Dr Stephen Chia at the University of British Columbia in Vancouver.

As part of the study, researchers compared outcomes of 2150 women diagnosed with metastatic breast cancer in the Canadian province of British Columbia between 1991 and 2001 and evaluate whether new hormonal and chemotherapeutic drugs approved for public use actually had an impact on survival outside the clinical trial setting. — ANI

Teenage girls ahead of boys in binge drinking

LONDON: When it comes to binge drinking, teenage boys are no competition for girls of their age group, a survey has found.

The survey was conducted by the UK’s Schools Health Education Unit, which questioned more than 20,000 teens about their drinking habits.

The researchers found that as compared to a fifth of boys, nearly a quarter of girls aged between 14 and 15 admit to having so much alcohol that they drunk at least once a week.

Teenage girls, the survey also found, prefer drinks with a higher alcohol content, such as spirits, than wine and beer than most boys their age prefer. — ANI

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